Provider Demographics
NPI:1548601818
Name:CHALMERS P. WYLIE , AMBULATORY CARE CENTER
Entity Type:Organization
Organization Name:CHALMERS P. WYLIE , AMBULATORY CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER/MENTAL HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LSW
Authorized Official - Phone:614-257-5498
Mailing Address - Street 1:420 N JAMES RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1834
Mailing Address - Country:US
Mailing Address - Phone:614-257-5498
Mailing Address - Fax:614-257-5205
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-5498
Practice Address - Fax:614-257-5205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0900647261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS. 0900647OtherSTATE OF OHIO COUNSELOR AND SOCIAL WORKER, MARRIAGE AND FAMILY THERAPIST BOARD